Thomas Elias: Prop. 8 goes too far, interferes with medical care

Suppose for a moment that your favorite relative — father, mother, aunt, uncle, brother or sister — were getting urgently needed cancer treatment and California's government suddenly decreed the doctor could not include his assistant's pay in any fees he charged. So he fires his assistant and then has less time to devote to caring for your loved one.

Would that constitute interference with the doctor-patient relationship, an act no sane politician would ever want to be accused of?

And yet … well over 569,000 Californians signed off on an initiative that would do essentially the same thing to the 139,000 patients now getting treatment at the state's more than 550 dialysis clinics. These are places where people whose kidneys have failed get their blood cleansed of toxic substances several times weekly, the only way they can survive more than a few weeks.

This initiative will be on the November ballot as Proposition 8, and it's almost a sure thing that dialysis patients will get lower quality care than they do today if it passes.

Yes, there are flaws in today's system. For one example, two multinational companies, the German-based Fresenius Medical Care and the Denver-based DaVita Corp., operate 70 percent of California dialysis centers, places where patients are hooked up to blood-cleansing machines via large needles inserted into their arms or chests.

That creates a non-competitive situation and most likely drives up the cost of dialysis treatment, from which a kidney transplant is the only way to escape alive. There are legitimate complaints about staffing levels and the fact that some patients must drive many miles to get treatments.

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But Prop. 8 could make a flawed situation much worse.

Sponsored primarily by the Service Employees International Union, which would like to recruit most dialysis technicians, it would forbid clinics from charging insurance companies for the work of physician medical directors vital to maintaining quality care. It would not allow clinics to charge for the work of facility administrators, security personnel and professional services like accounting, payroll and legal expenses.

It does this not by naming specific areas where payments are banned, but by listing classes of work where payment is allowed. The measure does not cover the substantial percentage of California patients whose treatments are covered under Medicare and Medi-Cal.

It also limits what clinics can charge to 15 percent above what is spent directly for patient care by nurses and technicians and the equipment and supplies they use. Clinic directors and the doctors who oversee operations would have to be paid from that 15 percent, leaving almost no room for profits.

If Prop. 8 passes, Fresenius and DaVita, both very profit-conscious companies that have bought up many previously doctor-owned dialysis clinics, might sell off many of their facilities to buyers with unknown qualifications.

So it's no wonder most physician groups oppose the measure, for which the SEIU had already spent more than $5 million as of early August. They contend Prop. 8's strict rules would force clinics to cut back staff, including supervising nurses who often are vital to solving patients' problems. And that, they say, could reduce access to dialysis centers.

Said Dr. Aimee Moulin, president of the California chapter of the American College of Emergency Physicians, "This proposition will leave this fragile population no choice but to go to the emergency room for treatment, or increase their threat of life-threatening complications. Treating dialysis patients in the emergency room is more expensive and drives up the cost of…the entire health care system."

Added kidney specialist Byron Wong MD of Berkeley in an essay, "The (payments allowed) would not cover the cost of providing high-quality care…Patients would have to travel farther…and chances would increase that they will miss a treatment."

In short, no previous ballot measure has ever attempted to interfere so strongly with the medical care of any one patient group. That makes Prop. 8 a bad precedent which could lead to more interference in other types of care. It deserves a strong "no" vote.

(Full disclosure: Columnist Elias has had a kidney transplant since 1997. He underwent regular dialysis treatments for many months prior to his transplant.)

Email Thomas Elias at tdelias@aol.com. His book, "The Burzynski Breakthrough, The Most Promising Cancer Treatment and the Government's Campaign to Squelch It" is now available in a soft cover fourth edition. For more Elias columns, visit http://www.californiafocus.net